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UKMLA > Neurology > Flashcards

Neurology Flashcards

1
Q

Symptoms of Charcot - Maries Foot

A

high arch foot
sharp shooting pain of feet

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2
Q

what infection precedes Gillian barre?

A

campylobacter jejuni

(gastroenteritis symptoms)

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3
Q

presentation of Gillian barre

A

reduced reflexes
cranial nerve 7 palsy and diplopia
respiratory muscle weakness

SYMMETRICAL ASCENDING WEAKNESS BEGINS FEET PROGRESSES UPWARDS

4 weeks of trigger

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3
Q

investigation for Gillian barre?

A
  1. nerve conduction studies
  2. lumbar puncture ++protein normal cell count and glucose
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3
Q

DAVID acronym for peripheral neuropath causes?

A

D - Diabetes
A - alcoholic peripheral neuropathy
V -

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4
Q

management for Guilian barre?

A
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5
Q

vitamin deficiencies

A

B12

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6
Q

Infections

A

shingles
HIV
herpes

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7
Q

types of seizures

A

tonic clonic
partial focal (focal aware)
myoclonic
focal impaired seizure
tonic seizure
atonic seizure

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7
Q

Diseases - autoimmune

A

charcot maries
guillian barre

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8
Q

tonic clonic seizure explained?

A
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9
Q

investigations for seizures

A

EEG
MRI brain = structural pathology
blood glucose (HbA1c)
U&E = electrolyte imbalance
blood culture
urine dip
lumbar puncture (sepsis, encephalitis or meningitis)
ECG = cardiac syncope

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10
Q

advice for patients?

A

showers not bath
12 month seizure free before can drive

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10
Q

what is teratogenic in anti epileptics?

A

sodium valproate

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11
Q

what is given to child bearing patents with seizures?

A

lamotrigine, levetiracetam

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12
Q

what is given for absent seizures?

A

ethosuxamide

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13
Q

myoclonic women who are able to have children?

A

levetiracetam

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14
Q

essential tremor what it is?

A

fine tremor affecting all voluntary muscles

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15
Q

what is an action tremor?

A

essential tremor

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15
Q

what tremor is absent at sleep?

A

essential tremor

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16
Q

when is an essential tremor better?

A

alcohol

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17
Q

is essential tremor asymmetrical or symmetrical?

A

symmetrical

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18
Q

location of essential tremor?

A

hands and head usually

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19
Q

What is MND?

A

progressive and eventually fatal condition where motor neurones stop functioning

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19
Q

presenting symptoms of MND

A

usually late middle aged man, increased fatigue of muscles and fatigue after exercise e.g., foot drop

usually first noticed in upper limbs

  1. trips and clumsiness are first sign
  2. increased tone and spasticity
  3. upping plantar reflex
  4. muscle wasting reduced tone
  5. reduced reflexes
  6. slurred speech and dysarthria

(UMN AND LMN SIGNS)

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19
Q

management of essential tremor?

A

propanolol

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19
Q

what is the second most common MND type?

A

progressive bulbar palsy
- affects muscle of talking and swelling (most severe)

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19
Q

investigations to diagnose MND

A

clinical diagnosis made by specialists

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20
Q

what is the management of MND

A

no cure

Riluzole can slow progression if they have ALS and extend life over months

NIV for respiratory weakness

management for maintaining quality of life.

usually die from respiratory failure and pneumonia

20
Q

What is the most common type of MND

A

ALS

20
Q

multiple sclerosis?

A

chronic progressive condition where immune system attacks myeline sheath, impacts oligodendrocytes

20
Q

what other types of MS are there?

A

secondary progressive (elongated periods of relapse)

primary progressive
(symptoms for a year without disease free period)

21
Q

most common MS type?

A

relapsing-remitting

21
Q

nutrition method preferred for MND?

A

PEG

21
Q

symptoms of MS

A
  1. optic neuritis (demyelination of optic nerve, unilateral impaired vision, pain moving eyes, colour differences)
    - central scatoma
  2. diplopia
  3. focal weakness (corners, facial nerve palsy, paralysis, incontinence)
  4. focal sensory numbness
    (electric shock sensation on neck flexion)
  5. ataxia
21
Q

what is lhermittes sign?

A

electric shock on flexion of neck

if positive = MS

22
Q

investigations for MS?

A
  1. MRI scan to see lesions
  2. neurologist clinical picture
  3. lumbar puncture
    (oligoclonal bands in lumbar puncture in the CSF)
23
Q

management for MS?

A

Flare up treatment: STEROIDS
- high dose oral steroids
- IV steroids 3-5 days if eye involvement

natalizumab ocrelizumab = used to induce long term remission

24
Q

What is myasthenia gravis

A

autoimmune condition for muscle weakness

worse activity better at rest

usually women <40 men >60

associated with thymoma

  • motor neurone communicate with neuromuscular junction.

ACH antibodies are produced and block the AcH receptors

25
Q

most common antibodies to be seen in myasthenia graves?

A

ACh receptor antibodies

  1. Muscle specific Kinase (MUSK)
  2. LRP4 (low density lipoprotein)
26
Q

presenting symptoms of Myasthenia Gravis?

A
  • eyelid weakness (drooping eyelid)
  • double vision
  • worsening with activities
  • climbing stairs, raising hands up head
  • jaw fatigue and swallowing issue
  • weakness in facial movements and slurred speech?
27
Q

investigations of myasthenia gravis

A

blood AcH, MuSK and LRP4

CT or MRI thymoma

28
Q

management for myasthenia gravis

A

pyridostigmine is mangat treatment for myasthenia graves

prednisolone for immunosuppression
thymectomy
rituximab

29
Q

what is parkinson’s disease

A

reduction of dopamine from basal ganglia

30
Q

3 and more cardinal symptoms of Parkinson’s

A
  1. resting tremor (unilateral) - pill rolling, worse when distracted
    2.cogwheel rigidity
  2. bradykinesia (slowing of movements)
  3. stoop posture
    5.lack of arm swing
  4. shuffling gait
  5. hypomania (no facial expression)
31
Q

parkinson + sydromes?

A

4 main ones
- multi system atrophy
- dementia with lewy bodies (dementia with parkinsonian features, visual hallucinations, fluctuating consciousness)
- progressive supranuclear palsy
- cortical basal degeneration

32
Q

management for Parkinson’s

A

refer to neurologist and give levodopa

co-beneldopa (peripheral decarboxylase inhibitor) given to prevent breakdown

MOAI (selegiline) prevent breakdown

COMT (entcapone) prevent breakdown

Cabergoline (dopamine agonist)

33
Q

cabergoline can develop into what?

A

pulmonary fibrosis

34
Q

what will spinal cord injury present with?

A
  1. motor symptoms
    - weakness or paralysis
    - UMN signs
  2. sensory symptoms
    - shock burning
    - loss or alteration
  3. Pain
    - neuropathic
  4. autonomic
    - HTN and bradycardia
    - bladder and bowel dysfunction (IF BELOW T11/12)
    - Sexual dysfunction
35
Q

anterior cord syndrome

A

loss of motor and pain/temp
preserved proprioception
anterior spinal artery occlusion

35
Q

investigations for since cord injury?

A

CT spine
MRI for soft tissue

35
Q

central cord syndrome ?

A

impacts the upper>lower

usually elderly patients with hyperextension injuries of neck

35
Q

brown squared syndrome?

A

usually penetrating trauma

-ipsilateral motor function loss
-contralateral temp and pain loss

36
Q

subarachnoid haemorrhage presentation ?

A

usually ruptured cerebral aneurysm in the brain

between pia and arachnoid membrane

  1. thunder clap headache which reaches max intensity 30s-1min
  2. usually in sex or heavy lifting
  3. neck stiffness, vomiting and photophobia
  4. visual changes, dyshagia and lack of consciousness, week of headaches

LACK OF FEVER = NO MENINGITIS

36
Q

management of spinal cord lesions

A

IV methylprednisolone
surgical decompression or referral

37
Q

risk factors for subarachnoid haemorrhage

A

family history
PCOS
HTN
Smoking
Excessive alcohol
cocaine use
sickle cells

37
Q

investigations for subarachnoid haemorrhage?

A

CT head first line WITHIN 6 HOURS OF SYMPTOMS ONSET

lumbar puncture otherwise = look for yellow colour (xanthochromia , increased bilirubin)

ECG

CT angio to locate

37
Q

medical management for subarachnoid haemorrhage

A

Nimodipine used to prevent vasospasm which cause brain ischaemia

38
Q

subdural haemorrhage cause?

A

shearing of bridging vein - whiplash

high impact injuries

38
Q

surgical management for subarachnoid

A

coiling

39
Q

investigation for subdural haemorrhage?

A

CT scan show crescent shape

40
Q

management of subdural haemorrhage

A
41
Q

where does bleeding present on CT in subarachnoid?

A

ventricles and cystines (middle of brain)

42
Q

extradural haemorrhage causes?

A

middle meningeal in temporparietal region

42
Q

biconvex CT scan what is it?

A

extradural

43
Q

what is subarachnoid?

A

rupture of aneurysm

44
Q

dilated pupil is indicated of what haemorrhage

A

extradural haemorrhage

45
Q

trigeminal neuralgia impacts what nerve?

A
46
Q

what triggers trigemnial neuralgia what is the cause?

A

pinprick sharp feelings over the face

small muscle movements usually cause pain (washing, shaving, smoking, talking)

unilateral

46
Q
A
47
Q
A
47
Q

management for trigeminal neuralgia?

A

carbamazepine

failure to respond then referral

UKMLA (11 decks)

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